Multipurpose implant with modeled surface structure for soft tissue reconstruction

ABSTRACT

Embodiments of a multi-purpose implant for use in surgery, such as for reconstruction of soft tissues, are disclosed. In some embodiments, the implant includes elastic polymer film made from a suitable biologically compatible polymer. The implant also includes a reinforcement element formed from a polyurethane mesh or other strong and stable woven or unwoven synthetic material. The reinforcement element can be fully enclosed by the film so that only the film comes into contact with the organs and tissues. Anti-adhesive properties or control over implant&#39;s integration into a body can be determined by the preset surface structure of the implant, while physical and mechanical properties, such as strength and elasticity of the implant, are obtained by virtue of reinforcement element geometry.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to Russian Patent Application No. 2014108943, filed on Mar. 7, 2014, and U.S. Provisional Patent Application No. 61/979,895, filed on Apr. 15, 2014, which are incorporated by reference in their entirety.

BACKGROUND

1. Technical Field

This disclosure relates to the field of medicine and, in some embodiments, to plastic and reconstructive surgery, and is intended for broad application in surgery on patients suffering from diseases and injuries involving a deficiency of soft tissue.

2. Description of the Related Art

Modern methods of soft tissue reconstruction call for the simultaneous use of materials that frequently have several incompatible properties. For example, in treating ventral hernia through the intra-peritoneal on-lay mesh method (laparoscopic IPOM), the synthetic implant material should ensure anti-adhesion on the visceral side (facing the internal organs). On the parietal side (facing the abdominal wall) it is desirable to ensure the tissue's controllable integration into the implant. The growing tissues should not shrink or crimple the implant in the distant post-operation period. At the same time, the tissue integration should reliably secure it to the abdominal wall tissue.

The porous structure of the implant surface should also meet criteria. For instance, macrophage cells and neutrophiles, killers of bacteria, are unable to penetrate fine pores measuring less than 10 μm. This enables the bacteria, smaller than 1 μm, to form colonies in pores measuring less than 10 μm and in spaces of multi-filament meshes, which causes a risk of infection. Therefore it is desirable for the implant to have a structure in which the pores and gaps in the mesh plexus nodes would not be below 75 μm. See C N Brown, J G Finch “Which mesh for hernia repair?”. Ann R Coll Surg Engl. 2010 May, available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025220/. It is desirable that the synthetic implant should have a minimum tissue response and be strong and elastic enough for clinical applications. It is desirable that the implant should be able to be sutured or fastened with a surgical stapler. The strength of the implant should be commensurable to the stress sustained by the abdominal wall during coughing, jumping. etc. (e.g., tensile strength up to 32 N/cm). At the same time, the implant should feature elasticity close to that of the abdominal wall (e.g., up to 38% at the maximum stress).

The task of creating such an implant has not been fulfilled since the implants known to date do not provide all of the desired capabilities.

Currently available implants contain layers of different non-absorbable materials fastened together by some means. In most cases, the layer that ensures integration of the abdominal wall tissues is a polypropylene or polyester mesh whilst the layer that provides the anti-adhesive barrier is made from polytetrafluoroethylene or, for instance, collagen. Such designs are described in the following patents and publications: U.S. Pat. No. 6,258,124 titled “Prosthetic repair fabric”, U.S. Pat. No. 6,652,595 titled “Method of repairing inguinal hernias”, U.S. Pat. No. 5,743,917 titled “Prosthesis for the repair of soft tissue defects”, U.S. Patent Publication No. 20020052654 titled “Prosthetic repair fabric”, U.S. Pat. No. 8,206,632 titled “Method of making composite prosthetic devices having improved bond strength”, and U.S. Pat. No. 8,623,096 titled “Double layer surgical prosthesis to repair soft tissue,” the entirety of each is hereby incorporated by reference.

Implants are available that are essentially in the form of a mesh from a stable strong material (polypropylene, polyester or other) coated with a temporary absorbable anti-adhesive material. The mesh is designed for soft tissues to grow into it whilst the absorbable layer, separating the mesh from visceral tissues, creates a temporary anti-adhesive barrier promoting the formation of peritoneum and minimizing the probability of union with the mesh during the wound healing. Following the biological degradation of the barrier, the mesh integrates into the abdominal wall tissue.

Such designs are described in the following, publications: U.S. Patent Publication No. 20130317527 titled “Single plane tissue repair patch having a locating structure”, U.S. Patent Publication No. 20130267971 titled “Single plane tissue repair patch”, and U.S. Patent Publication No. 20130267970 titled “Single plane tissue repair patch,” the entirety of each is hereby incorporated by reference. An example of commercial use of such a design is an implant under the trade name of PHYSIOMESH manufactured by ETHICON, Inc.

All these implants feature strength that ensures a high restorative effect and are fit for suture-aided fixation, but are disadvantageous in some aspects.

By virtue of its micro-porous structure, polytetrafluoroethylene mollifies the gravity and reduces the commissural side effects of the healing process, but does not altogether eliminate them. The use of collagen implies a high risk of a tissue rejection, allergic response or infection.

Another disadvantage is the shrinkage of the implant, which is specific to materials known to date (polypropylene, polyester). Growing through the mesh, the organism tissues contribute to its extra shrinkage and wrinkling, which negatively impacts the quality of the patient's life.

It is not recommended to introduce implants coated with a temporary absorbable anti-adhesive material in the event of a casual or scheduled opening of the digestive tract lumen or in the event of infection of the site since this may result in the infection of the implant itself, as its absorbable material promotes colonization of microorganisms, which may trigger a post-operative pyoinflammatory process.

These implants have either a mesh-like or porous structure, which ensures integration of the abdominal wall tissues, but makes it impossible to control the size of the mesh pore and cell. The material structure is usually determined by the range of pore and cell size. In woven materials the mesh weave areas are inaccessible during sterilization and are potentially a place of microbial contamination and a site of bacterial infection.

All these factors may restrict the use of implants in various clinical cases.

SUMMARY

For purposes of summarizing the disclosure, certain aspects, advantages and novel features of the disclosure have been described herein. It is to be understood that not necessarily all such advantages can be achieved in accordance with any particular embodiment disclosed herein. Thus, the embodiments disclosed herein can be embodied or carried out in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other advantages as can be taught or suggested herein.

The aim of certain embodiments of this invention is to provide a new implant, method of manufacture and method of use that addresses, reduces, or eliminates one or more of the above said disadvantages and/or fulfills one or more of the desired capabilities mentioned above.

In some embodiments, this task is fulfilled by creating a multi-purpose implant for reconstructing soft tissues, e.g., an implant in which the anti-adhesive properties or control over its integration is determined by the preset surface structure whilst physical and mechanical properties, such as strength and elasticity of the implant, are obtained not by changing the implant's chemical composition, but by virtue of reinforcement element geometry. The multi-purpose implant can be useful in different areas of surgery in operative treatment involving soft tissue deficiency. Embodiments of the disclosed implant are not limited to reconstruction of soft tissue and can be used in any surgical application, including plastic and reconstructive surgery. For instance, disclosed, embodiments can be used for hernia repair, neurosurgery, oncology, and others uses.

In some embodiments, the implant is presented in the form of an elastic polymer film (or a patch) from hydrophobic spatially linked (or spatially sutured) polymer based on the methacrylic row oligomers and monomers or any other biologically compatible polymer. The implant also includes a reinforcement element from a polyurethane mesh or other strong and stable woven or unwoven synthetic material. In some embodiments, the reinforcement (or armored) element is fully enclosed by the film so that only the spatially sutured polymer comes into contact with the organs and tissues. Depending on the clinical application and goals, the surface area of the reinforcement element can match the surface area of the film and the reinforcement element can be enclosed by the film. In other embodiments, the reinforcement element can be cut into separate segments, which can be enclosed by the film, and the aggregate surface area of the segments of the reinforcement element can be smaller than the surface area of the film. The reinforcement element can be non-degradable.

In some embodiments, the surface structure of the spatially sewn or sutured polymer is not porous and is preset during manufacture in compliance with the prospective clinical application. In case two or one surface or any area on the implant surface serves as an anti-adhesive barrier, then a high level of smoothness is set during manufacture. For example, the surface roughness may not exceed about 50 nanometers, such as be between about 5 and about 20 nanometers. At least the smooth surface can be nonporous so as to prevent or minimize the risk of creating undesired tissue formations (or spikes). The surface of an implant can be inert in order to decrease the reaction of the tissues to the implant. In order to achieve this, the polymer may undergo additional procedure of blocking of free radicals, for example by means of processing of a surface of isopropyl alcohol. Such a level of smoothness prevents the commissure formation (e.g., tunica growth and adhesion, radicular-muscular accretion, etc.) and enables the tissues, contacting with this surface, to move and slide freely.

The production process can exclude the generation of free radicals, which minimizes the triggering of a tissue response.

In some embodiments, where it is desirable for two surfaces or one surface or any area on the implant surface to ensure a strong fixation with adjacent tissues, then the surface is formed as an embossed blind-ended (or not open-ended) pattern or a certain surface roughness is preset. For instance, the surface roughness may be not less than about 10 microns, not more than about 50 microns, etc. The embossed pattern can be made in the form of a mesh, cells, characters, letters, number, and various figures with a preset shape, size and depth. In the post-operative period the adjacent tissues can grow into the cells of this embossed pattern without penetrating the polymer. Thus, in some embodiments, in the post-operative period the tissues that have grown into the tissue cells are unable to shrink, wrinkle, or destroy the implant.

In some embodiments, creation of a surface structure with controllable size, depth and shape of cells makes it possible to control the tissue growth, prevent shrinkage, and avoid infection. Due at least in part to the size and depth of the pores on the surface intended for integration into the tissue, controlled growth of tissue cells and integration of the implant into the body can be achieved, while shrinkage and infection of the pores can be avoided. Research has proven the need for controlling the surface structure of implants used for soft tissue reconstruction, as is described, for instance, in the article “Which mesh for hernia repair?” by C N Brown, J G Finch, published in Ann R Coll Stag Engl. 2010 May (available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025220/), the entirety of which is hereby incorporated by reference.

In some embodiments, the reinforcement element may be woven or unwoven, and of different thickness (for instance, 20-50 microns). The reinforcement element can include synthetic material. It can be made from polyamide, polypropylene, polyethylene terephthalate, polyvinylidene fluoride, or a combination of these materials. The reinforcement element can be fully or partially included in the implant all over its area. In places where the reinforcement element is missing, the polymer film can be continuous (or unbroken) or mesh-like or contain holes, such as through holes, of different size and shape. When the size (or surface area) of the reinforcement element matches the size of the implant, the film can have mesh surface or include holes, such as through holes, of different size and shape

In some embodiments, the reinforcement element makes it possible to suture and fasten the tissues by a surgical stapler using an elastic polymer film whilst the partial reinforcement of the polymer film enables controlling the implant's physical and mechanical capabilities without changing the polymer's chemical composition, i.e. allows presetting a certain elasticity (radial stretch percentage), strength, and a possibility of suturing in compliance with the clinical application. Some embodiments achieve controlling the strength of the implant and the extent of its stretching not by changing the polymer composition, but by maintaining the geometry, size, and density of the reinforcement element. For example, the strength of the implant can depend at least on the thickness of the reinforcement element.

In some embodiments, the implant can be manufactured by polymerization in molds, in which their surface can be super-smooth (for instance, not more than 50 nanometers) or with a preset topography (embossed pattern). The manufacturing process may use any available polymerization method, such as photopolymerization, thermal polymerization and others. As an example, disclosed embodiments are an improvement over the embodiments described in European Patent Publication No. EP 2644348 titled “A method of manufacturing an artificial elastic implant for restorative and reconstructive surgery,” which is incorporated by reference in its entirety. Embodiments of the implants, methods and other features described in EP 2644348 may also be applied to embodiments described in this application.

In some embodiments, a multi-purpose surgical implant for reconstruction of soft tissues includes an outer surface having an elastic film formed from a biologically compatible polymer and a reinforcement element enclosed by the elastic film.

The implant of the preceding paragraph may also include any combination of the following features described in this paragraph, among others described herein. The reinforcement element may not contact body organs and tissue during implantation. The biologically compatible polymer can include spatially linked polymer based on methacrylic row oligomers and monomers. The reinforcement element can have a thickness and shape adapted for controlled integration into a body. The surface area of the reinforcement element can be substantially the same as a surface area of the elastic film. The implant can include a plurality of through holes of different size and shape.

The implant of the preceding paragraphs may also include any combination of the following features described in this paragraph, among others described herein. The surface area of the reinforcement element can be smaller than a surface area of the elastic film. One or more regions of the film that do not enclose the reinforcement element can have a mesh surface or include a plurality of through holes of different size and shape. One or more regions of the film that that do not enclose the reinforcement element can be unbroken.

The implant of the preceding paragraphs may also include any combination of the following features described in this paragraph, among others described herein. The reinforcement element can include woven synthetic material configured to stabilize and strengthen the implant. The reinforcement element can include unwoven synthetic material configured to stabilize and strengthen the implant. The reinforcement element can include at least one of polyamide, polypropylene, polyethylene terephthalate, and polyvinylidene fluoride. The outer surface can include a first surface and a second surface opposite the first surface, and at least one of the first and second surfaces can be substantially smooth and non-porous. The at least one of the first and second suffices can have a roughness that does not exceed about 50 nanometers. The outer surface can be processed so as to block free radicals, thereby decreasing a risk of tissue reaction. The outer surface can be treated with isopropyl alcohol.

The implant of the preceding paragraphs may also include any combination of the following features described in this paragraph, among others described herein. The outer surface can include a first surface and a second surface opposite the first surface, and at least one of the first and second surfaces can include an embossed pattern configured to facilitate fixation with adjacent tissue. The embossed pattern can have a roughness of not more than about 50 microns. The embossed pattern can include at least one of mesh, numbers, and letters.

In some embodiments, a surgical implant includes a non-degradable reinforcement element at least partially enclosed in a polymer film, the film including spatially linked polymer obtained by photopolymerization of methacrylic oligomers and monomers. Photopolymerization can be thermal polymerization.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present application will now be described hereinafter, by way of example only, with reference to the accompanying drawings in which:

FIGS. 1A-1C illustrate a top view, a profile view and a perspective view, respectively, of an implant according to some embodiments.

FIGS. 2A-2C illustrate a top view, a profile view and a perspective view, respectively, of another implant according to some embodiments.

FIGS. 3A-3C illustrate a top view, a profile view and a perspective view, respectively, of another implant according to some embodiments.

FIGS. 4A-4C illustrate a top view, a profile view and a perspective view, respectively, of another implant according to some embodiments.

FIGS. 5A-5C illustrate a top view, a profile view and a perspective view, respectively, of another implant according to some embodiments.

FIGS. 6A-6C illustrate a top view, a profile view and a perspective view, respectively, of another implant according to some embodiments.

DETAILED DESCRIPTION

While certain embodiments are described, these embodiments are presented by way of example only, and are riot intended to limit the scope of protection. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms. Furthermore, various omissions, substitutions, and changes in the form of the methods and systems described herein may be made without departing from the scope of protection.

FIGS. 1A-1C illustrate an implant according to some embodiments. The implant of FIGS. 1A-1C is illustrated having a square shape, but it will be appreciated that this and other implants may have any desired shape. The illustrated implant has a profile section with a reinforcement element (1) covered with the film across the entire surface area of the element. The illustrated implant has both surfaces (2) that are smooth. The drawing in the FIG. 1A schematically illustrates the implant, while the drawing in FIG. 1C depicts a manufactured implant.

FIGS. 2A-2C illustrate an implant according to some embodiments. The illustrated implant has a profile section with a reinforcement element (1) covered with the film across the entire surface area of the element. The illustrated implant has one surface (3) that is smooth, while the other surface (4) is textured or embossed, The smooth surface (3) can be anti-adhesive so as to minimize tissue adhesion, while the textured surface can promote adhesion and integration into the tissue. The drawing in FIG. 2A schematically illustrates the implant, while the drawing in FIG. 2C depicts a manufactured implant.

The embossed surface (4) can include a pattern of a preset size, depth and cell (or pore) shape. For example, the pattern can include cells measuring about 75 μm (microns) by about 75 μm and be about 50 μm deep. As another example, the cells can measure about 75 μm in diameter and be about 50 μm deep. The cells can have circular, rectangular, hexagonal, or any other suitable shape and can be of any suitable size. The pattern may include cells of more than size and shape. For example, the embossed pattern can be in the form of a mesh, numbers, letters or their combination. The embossed pattern can be regular (e.g., not open-ended). The embossed surface can facilitate fixation to adjacent tissue.

FIGS. 3A-3C illustrate an implant according to some embodiments. The illustrated implant has a profile section with a reinforcement element (1) covered with the film across the entire surface area of the element. The illustrated implant has both surfaces (5) that are textured or embossed. The drawing in FIG. 3A schematically illustrates the implant, while the drawing in FIG. 3C depicts a manufactured implant.

FIGS. 4A-4C illustrate an implant according to some embodiments. The illustrated implant has a profile section with a reinforcement element (1) covered with the film across the entire surface area of the element. The illustrated implant has one surface (6) that is smooth, while the other surface (7) is textured or embossed. The pattern of the textured surface is a pattern of hexagons regularly repeated over the entire surface. The drawing in FIG. 4A schematically illustrates the implant, while the drawing in FIG. 4C depicts a manufactured implant. The textured surface (7) is illustrated by the drawings in FIGS. 4A and 4C.

In some embodiments, the reinforcement element can cover or be embedded in less than the entire surface area of the implant. For example, the implant can include one or more reinforcement element sections. Sections of the reinforcement element can have any suitable shape, such as square, rectangular, circular and radial strip shape. In some embodiments, sections of the reinforcement element can be covered with film on both sides, with the film covering not only synthetic material but also portions extending between sections of the reinforcement element. The film may have the same texture as sections of the implant that do not include the reinforcement element inside the film. In other embodiments, sections of the reinforcement element can be covered with film having different smoothness or texture as sections of the implant that do not include the reinforcement element inside the film. For example, sections of the reinforcement element can be covered with smooth film while other sections of the implant that do not include the reinforcement element have textured film.

FIGS. 5A-5C illustrate an implant according to some embodiments. The illustrated implant has a profile section with a reinforcement element (1) not covering or being embedded within the entire surface area of the implant. In the illustrated implant, the reinforcement element forms radial rays (or strips) extending from the center of the circle, and the reinforcement element also extends along the periphery of the circle. The reinforcement element can be covered by a polymer film (illustrated as having a circular shape) on both sides. The polymer film may have the same or different texture than the texture of the film in the sections (illustrated as sectors) not having the reinforcement element inside the film. For example, the reinforcement element can be covered with smooth film while other sections having no underlying reinforcement element may have textured film (e.g., such sections may have partially mesh-like texture). The reinforcement element can be cut into desired shapes (e.g., strips and circle) using laser cutting. The drawing in FIG. 5A schematically illustrates the implant, while the drawing in FIG. 5C depicts a manufactured implant. The drawing in FIG. 5C illustrates the textured and smooth surfaces of the implant.

FIGS. 6A-6C illustrates an implant according to some embodiments. The illustrated implant has a profile section with a surface area of a reinforcement element (1) being smaller than the surface area of the implant. In the illustrated implant, the reinforcement element forms radial rays (or strips) extending from the center of the circle, and the reinforcement element also extends along the periphery of the circle (e.g., extends circumferentially). The reinforcement element can be covered by a polymer film (illustrated as having a circular shape) on both sides. The film on opposite sides may have the same or different characteristics. One surface (8) of the implant on one side of the reinforcement element can be smooth, while the other surface (9) on the other side of the reinforcement element can be textured or embossed. The drawing in FIG. 6A schematically illustrates the implant, while the drawing in FIG. 6C depicts a manufactured implant. The drawing in FIG. 6C illustrates a cross-sectional view of the implant and depicts the reinforcement element having radial rays sections extending from the center and a section extending along the periphery of the implant.

Although the present disclosure includes certain embodiments, examples and applications, it will be understood by those skilled in the art that the present disclosure extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses and obvious modifications and equivalents thereof, including embodiments which do not provide all of the features and advantages set forth herein. For example, while FIGS. 1-6 depict embodiments that have square or circular shapes, implants may have any other suitable shape. Accordingly, the scope of the present disclosure is not intended to be limited by the specific disclosures of preferred embodiments herein, and may be defined by claims as presented herein or as presented in the future. 

1. A multi-purpose surgical implant for reconstruction of soft tissues comprising: an outer surface having an elastic film formed from a biologically compatible polymer, wherein the outer surface is processed so as to block free radicals, thereby decreasing a risk of tissue reaction; and a reinforcement element enclosed by the elastic film, wherein the reinforcement element does not contact body organs and tissue during implantation.
 2. The implant of claim 1, wherein the biologically compatible polymer comprises cross-linked polymer based on multi-functional urethane (meth)acrylate oligomers and methacrylate monomers.
 3. (canceled)
 4. The implant of claim 1, wherein a total surface area of the reinforcement element is substantially the same as a total surface area of the elastic film.
 5. The implant of claim 4, further comprising a plurality of through holes of different size and shape.
 6. The implant of claim 1, wherein a total surface area of the reinforcement element is smaller than a total surface area of the elastic film.
 7. The implant of claim 6, wherein one or more regions of the film that do not enclose the reinforcement element have a mesh surface or include a plurality of through holes of different size and shape.
 8. The implant of claim 6, wherein one or more regions of the film that that do not enclose the reinforcement element are unbroken.
 9. The implant of claim 1, wherein the reinforcement element comprises woven synthetic material configured to stabilize and strengthen the implant.
 10. The implant of claim 1, wherein the reinforcement element comprises non-woven synthetic material configured to stabilize and strengthen the implant.
 11. The implant of claim 1, wherein the reinforcement element comprises at least one of polyamide, polypropylene, polyethylene terephthalate, and polyvinylidene fluoride.
 12. The implant of claim 1, wherein the outer surface comprises a first surface and a second surface opposite the first surface, and wherein at least one of the first and second surfaces is smooth and non-porous.
 13. The implant of claim 12, wherein the at least one of the first and second surfaces has a roughness that does not exceed about 50 nanometers.
 14. (canceled)
 15. The implant of claim 1, wherein the outer surface is treated with isopropyl alcohol.
 16. The implant of claim 1, wherein the outer surface comprises a first surface and a second surface opposite the first surface, and wherein at least one of the first and second surfaces comprises an embossed pattern configured to facilitate fixation with adjacent tissue.
 17. The implant of claim 16, wherein the embossed pattern has a roughness of not more than about 50 microns.
 18. A multi-purpose surgical implant for reconstruction of soft tissues comprising: an outer surface having an elastic film formed from a biologically compatible polymer, wherein the outer surface comprises a first surface and a second surface opposite the first surface, and wherein at least one of the first and second surfaces comprises an embossed pattern configured to facilitate fixation with adjacent tissue, the embossed pattern comprises at least one of mesh, numbers, and letters; and a reinforcement element enclosed by the elastic film, wherein the reinforcement element does not contact body organs and tissue during implantation.
 19. A surgical implant comprising a non-degradable reinforcement element at least partially enclosed in a polymer film, the film comprising cross-linked polymer obtained by photopolymerization of methacrylic oligomers and monomers.
 20. The implant of claim 19, wherein photopolymerization further comprises thermal heating.
 21. The implant of claim 1, wherein the elastic film is a continuous elastic film and the reinforcement element is fully enclosed by the continuous elastic film. 